Editorial: Heart Failure in Type 2 Diabetes – The “Forgotten” Complication

Left Ventricular Diastolic Dysfunction in Type 2 Diabetes-Progress and Perspectives

In-depth understanding of early cardiovascular manifestations in diabetes is high on international research and prevention agendas given that cardiovascular events are the leading cause of death for diabetic patients. Our aim was to review recent developments in the echocardiographic assessment of left ventricular diastolic dysfunction (LVDD) as a telltale pre-clinical disturbance preceding diabetic cardiomyopathy. We analyzed papers in which patients had been comprehensively assessed echocardiographically according to the latest LVDD guidelines (2016), and those affording comparisons with previous, widely used recommendations (2009). We found that the updated algorithm for LVDD is more effective in predicting adverse cardiovascular events in patients with established LVDD, and less specific in grading other patients (labelled "indeterminate"). This may prove instrumental for recruiting "indeterminate" LVDD cases among patients with type 2 diabetes mellitus (T2DM) in future screening programs. As an interesting consideration, the elevated values of the index E/e' can point to early diastolic impairment, foretelling diabetic cardiomyopathy. Identifying subclinical signs early makes clinical sense, but the complex nature of T2DM calls for further research. Specifically, longitudinal studies on rigorously selected cohorts of diabetic patients are needed to better understand and predict the subtle, slow onset of cardiac manifestations with T2DM as a complicating backdrop.

[Type 2 Diabetes Mellitus and Heart Failure: Innovative Possibilities for Management of Prognosis]

Type 2 diabetes mellitus (T2DM) has gone beyond the professional interests of one specialty. T2DM, cardiovascular (CV) diseases and chronic kidney disease, considered from the standpoint of a single cardio-reno-metabolic continuum, place a heavy economic burden on society. At the same time, the improvement of diagnostic methods and medical technologies led to distinct decrease in the frequency and mortality from a number of complications of T2DM, including myocardial infarction and stroke, but other states took their place. Thus, heart failure (HF) has taken the position of one of the most frequent complications with average prevalence of 24-40 % and significant predominance of HF with preserved ejection fraction (HFpEF). According to this paradigm, HFpEF is not a disease of diastolic dysfunction, but a systemic disease, the central element of which is impaired renal function. All this together has a potential value for choosing the optimal therapy. In recent years the results of specially designed studies assessing the CV-safety of antidiabetic drugs from the groups of dipeptidyl peptidase-4 (DPP4) inhibitors, glucagon-like preptide-1 (GLP-1) receptor agonists and sodium - glucose co-transporter-2 (SGLT2) inhibitors have become known. These drugs, except for SGLT2 inhibitors, by their mechanism of action affecting insulin resistance and hyperglycemia, demonstrated neutral or negative result on the frequency of hospitalizations due to HF. The EMPA-REG OUTCOME study with SGLT2, which has a special insulin-independent mechanism of action, demonstrated not only the efficacy and CV-safety of the drug in the form of a decrease in CV mortality by 38 %, but also a decrease in hospitalizations for HF by 35 %. Further studies with SGLT2 inhibitors confirmed positive effect on HF, indicating a class effect of the drugs. The recently completed study DECLARE-TIMI 58 proved the advantages of using dapagliflozin for the primary and secondary prevention of HF. This review highlights the prevalence of HF in diabetes mellitus, a new concept of the pathophysiology of HF, the main groups of sugar-lowering drugs and their effect on CV outcomes, in particular on HF.

The Indices of Nitric Oxide System in Rats with Carrageenan-Induced Enterocolitis Combined with Diabetes Mellitus

Background and aims: Diabetes mellitus (DM) represents a considerable public health issue, being one of the major causes of morbidity and mortality in the modern societies. Chronic hyperglycemia is accompanied by significant physiological, biochemical, and histological changes, e.g. development of oxidative stress that affects the motor activity of the intestine. This study aimed to evaluate the indices of nitric oxide (NO) system in blood serum and colon tissue supernatant of rats with carrageenan-induced enterocolitis combined with streptozotocin-induced diabetes.

Material and methods: The total NOS activity was determined by monitoring the rate of conversion of L-arginine into citrulline. The total quantity of NO metabolites was assessed by evaluating their amount, which included nitrite ions that were initially present in the sample (NO2 −) and nitrate ions reducted to nitrites (NO3 −).

Results: We found a significant increase in total NOS activity in colon tissue of all experimental groups vs. control animals (54.8, 30.6 and 79.2 % respectively). The total content of NO metabolites in colon tissue of all experimental groups also significantly increased (2.8, 1.9 and 3.4 times respectively) compared to the control animals.

Conclusions: We observed activation of nitroxydergic process in blood serum and colon tissue of rats with carrageenan-induced enterocolitis. Nitroxydergic processes markedly intensified in rats with carrageenan-induced enterocolitis combined with diabetes mellitus.